Practice Pointers

David Serur, MD, is Medical Director of the Kidney & Pancreas Transplant Program of New York-Presbyterian Hospital/Weill Cornell Medical Center, The Rogosin Institute, NY, NY. Adam Bingaman MD, PhD, is Director of Abdominal Organ Transplantation; Director, Live Donor Kidney Transplant Program; and Director, Renal Transplant Research Program; and also Kidney & Pancreas Transplant Surgeon at Methodist Specialty and Transplant Hospital, San Antonio, TX.

What changes in proteinuria occur during normal pregnancies?

How frequent is pregnancy in ESRD? What are the current outcomes?

One disease or many?

IgA nephropathy (IgAN) is well identified by dominant IgA glomerular deposits; however, this immunohistologic entity can be an asymptomatic chance finding or present with an extremely variable course. The variable clinical and histologic expressions are likely to be the result of genetic and environmental factors modulating common pathogenetic and progression mechanisms.

What is the current terminology for dysproteinemia-related kidney disease?

Which viruses cause glomerular disease?

IgA nephropathy (IgAN) is well identified by dominant IgA glomerular deposits; however, this immunohistologic entity can be an asymptomatic chance finding or present with an extremely variable course. The variable clinical and histologic expressions are likely to be the result of genetic and environmental factors modulating common pathogenetic and progression mechanisms.

This month, Kidney NewsEditorial Board member Edgar V. Lerma, MD, FASN, interviewed George Bakris, MD, FASN, FASH, FAHA, about recent SPRINT (Systolic Blood Pressure Intervention Trial) results. Dr. Bakris is professor of medicine and director of the ASH Comprehensive Hypertension Center at the University of Chicago Medicine.

KN: Why is the SPRINT study significant?

This month, Kidney News Editorial Board member Edgar V. Lerma, MD, FASN, interviewed George Bakris, MD, FASN, FASH, FAHA, about recent SPRINT (Systolic Blood Pressure Intervention Trial) results. Dr. Bakris is professor of medicine and director of the ASH Comprehensive Hypertension Center at the University of Chicago Medicine.

KN: Are we facing a higher incidence of nephrolithiasis?

Recent evidence suggests that over the past 4 decades, the incidence of kidney stones has increased in adults from 3.8 percent to 8.8 percent (1). In children, over the past 25 years, it has increased at a rate of 6 percent to 10 percent annually, reaching 50 cases per 100,000 adolescents (2).

Should ACEIs/ARBs be given to all diabetic patients?

The current guidelines are for angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blocking agents (ARBs) to be given to all diabetic patients without a contraindication if there is albuminuria, regardless of the presence of hypertension and independently of GFR.

Taking at least one hypertensive medication at bedtime instead of upon waking can reduce the risk of cardiovascular events by as much as two thirds, reports Ramón C. Hermida and associates in the December Journal of the American Society of Nephrology (JASN). This simple and costless approach could lead to significant improvements in outcomes for patients with high blood pressure (BP) whether or not they have chronic kidney disease (CKD) and could change how nephrologists administer antihypertensive drugs for their patients.

Kevin J. Martin

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Please define chronic kidney disease—mineral bone disorder (CKD-MBD). Is this interchangeable with renal osteodystrophy?

Bertram L. Kasiske

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Please characterize the typical lipid profile of patients with chronic kidney disease. Please describe its unique features compared with that of the general population.

One important reason for the limited use of peritoneal dialysis in the United States involves problems with the organization of peritoneal dialysis facilities. The basic structure and function of peritoneal dialysis facilities needs to be quite different from that of in-center hemodialysis facilities.

Peritoneal dialysis offers unique advantages for patients with ESRD. Peritoneal dialysis offers the convenience of home dialysis, allows continuous solute and fluid removal, and, for the incident dialysis patient, appears to be less harmful to residual kidney function (RKF). Many peritoneal dialysis patients have successfully used the therapy for a decade or longer without significant problems. To maximize success with peritoneal dialysis, providers must carefully attend to its many components.

Tushar J. Vachharajani

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Jack Work

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In this month’s issue, ASN Kidney News editorial board member Edgar Lerma interviewed Thomas Nevins, professor of pediatrics at the University of Minnesota Amplatz Children’s Hospital in Minneapolis, about nonadherence among patients—and care providers—in transplantation, dialysis, and kidney care in general.

What does the term nonadherence mean in nephrology?

Nephrologists in clinical practice take it for granted that when they arrive for morning rounds the hemodialysis machines will be set up and ready to go, with the water for the dialysate purified and inspected.

In fact, the level of water purity required to ensure patient safety has gradually evolved since hemodialysis was introduced many decades ago. The case study below, from a large community-based teaching hospital, illustrates how water quality can change unexpectedly, and the importance of rapid response to such changes to ensure patient safety.

Stuart Linas

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In this month’s issue, ASN Kidney News editorial board member Edgar Lerma interviewed Stuart Linas, MD, about the American Board of Internal Medicine (ABIM) Maintenance of Certification program for nephrologists. Linas is the Rocky Mountain Professor of Renal Research at the University of Colorado Denver School of Medicine.

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This month, Kidney News interviews Victor Gura, MD, developer of the wearable artificial kidney.

KN: Please tell us something about yourself.

How common is access rupture?

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What are some of the most important challenges facing nephrologists in prescribing dialysis therapy for their patients?

Sarah Prichard

Pediatric nephrology encompasses such a wide variety of conditions and illness severities that it may be hard to imagine that any one transition model could fit for all of nephrology. While it is true that transition programs must be adapted for different populations, there are basics that apply to them all.

Adhering to a strict medication regimen is difficult for anyone, but it can be particularly challenging for adolescents and young adults. Adherence is a skill that must be learned, and it requires organization, advanced planning, and good problem-solving skills, tools that adolescents and young adults are still developing. In fact, the part of the brain responsible for planning and for considering the impact of actions taken (or not taken) is not completely developed until one reaches their mid-20s!

Dr. Lorraine Bell

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Q: What is “transplant transition” and how did you get involved in this area?

Once estimated GFR (eGFR) indicates stage 3 or higher CKD (&lt;60 mL/min/1.73 m<sup>2</sup>), modification of drug dose, of dosing intervals, or of both should be considered.

In the January 2015 issue of ASN Kidney News:

  • New Guidance on Statin Use in Patients with CKD
  • Richard Lafayette, MD, FACP, Appointed Editor-in-Chief of ASN Kidney News
  • Kidney Watch 2015: A Look at the Year Ahead

Read the Dynamic Edition

How frequent is venous needle dislodgement?

How common is access rupture? According to data reported to the Centers for Medicare & Medicaid Services, fatal rupture of arteriovenous (AV) dialysis access accounts for close to 0.4 percent of all hemodialysis deaths, which translates into about one death per 1000 hemodialysis patient years. A recent retrospective review of cases reported to the medical examiner in the District of Columbia, Maryland, and Virginia suggested that there is significant underreporting of such deaths (1).

What are some of the most important challenges facing nephrologists in prescribing dialysis therapy for their patients? Ever since dialysis therapy has proved to be lifesaving, we have been challenged to decrease the mortality and increase the safety of the procedure (1). Advances in technology have led to increasingly complex equipment, resulting in a steep learning curve for both clinicians and patients alike.